New world cutaneous leishmaniasis in returned travellers: treatment failures using intravenous sodium stibogluconate

Treatment outcome was determined among a cohort of travellers who returned to the UK between February 2000 and February 2001 with New World cutaneous leishmaniasis caused by species of the Leishmania (Viannia) subgenus. Among 18 patients who completed treatment with 20 mg/kg/d of i.v. sodium stibogluconate (NaSb) for 20 d, early relapse of disease occurred in 2 patients with regional dissemination in 1 and mucocutaneous involvement in the other. Drug susceptibility testing in vitro of the clinical isolate from 1 of these patients confirmed tolerance to high concentrations of NaSb.

Review of the use of neuraminidase inhibitors for prophylaxis of influenza

Influenza causes significant morbidity and mortality particularly in vulnerable population groups. Although vaccination is recommended as the primary method of preventing influenza, antiviral drugs may play a complementary role. The National Institute for Clinical Effectiveness (NICE) has recently published guidance on the use of anti-viral drugs in the treatment of influenza, and further guidance on their use for prophylaxis is expected later in the year. In anticipation of this guidance this paper reviews the evidence for the effectiveness of the prophylactic use of neuraminidase inhibitors. Results of this review show that neuraminidase inhibitors are effective in preventing laboratory-confirmed clinical influenza in healthy adults, both when used as post-exposure prophylaxis for close and household contacts, and as seasonal prophylaxis in the wider community. Direct evidence in the elderly and institutions is too limited to draw firm conclusions about their effectiveness in that setting. However it seems probable that neuraminidase inhibitors would also be effective in these groups.

Reduced Kamin blocking in non paranoid schizophrenia: associations with schizotypy

Kamin blocking (KB) is an attentional phenomenon whereby prior learning about a stimulus (A) retards learning about a new stimulus (B) when later presented in compound (AB) with the original stimulus A. KB has been shown to be reduced in patients with schizophrenia. Using Oades' KB paradigm it has been suggested that drug treatment may influence the expression of KB abnormalities in patients. It is therefore unclear whether Reduced KB are due to drug treatment or to the illness itself. One experimental approach that circumvents drug treatment confounds is to study schizotypal traits in healthy volunteers. In the present study we investigated KB using the Oades paradigm in 27 healthy volunteers and 21 schizophrenic patients. We additionally investigated the relationship between KB performance and measures of schizotypal traits and a number of factors relevant to the experience of schizophrenia using the O-LIFE questionnaire. Our results indicate first a clear negative relationship between general schizotypy and more specifically, Unusual experiences (UNEX) and cognitive disorganisation (COGDIS) and KB performance. This relationship was qualitatively and quantitatively similar in both healthy volunteers and schizophrenic patients. Second we have independently replicated reduced KB in non-paranoid patients and no change in KB in paranoid patients using the Oades KB task. This study also confirms that reduced KB in non-paranoid patients is confined to early test trials (3-4) while the negative relationships with schizotypy scales UNEX and COGDIS that we have found are also confined to these early test trials confirming the psychological relevance of this specificity.

Receptor model source apportionment of nonmethane hydrocarbons in Mexico City

With the purpose of estimating the source contributions of nonmethane hydrocarbons (NMHC) to the atmosphere at three different sites in the Mexico City Metropolitan Area, 92 ambient air samples were measured from February 23 to March 22 of 1997. Light- and heavy-duty vehicular profiles were determined to differentiate the NMHC contribution of diesel and gasoline to the atmosphere. Food cooking source profiles were also determined for chemical mass balance receptor model application. Initial source contribution estimates were carried out to determine the adequate combination of source profiles and fitting species. Ambient samples of NMHC were apportioned to motor vehicle exhaust, gasoline vapor, handling and distribution of liquefied petroleum gas (LP gas), asphalt operations, painting operations, landfills, and food cooking. Both gasoline and diesel motor vehicle exhaust were the major NMHC contributors for all sites and times, with a percentage of up to 75%. The average motor vehicle exhaust contributions increased during the day. In contrast, LP gas contribution was higher during the morning than in the afternoon. Apportionment for the most abundant individual NMHC showed that the vehicular source is the major contributor to acetylene, ethylene, pentanes, n-hexane, toluene, and xylenes, while handling and distribution of LP gas was the major source contributor to propane and butanes. Comparison between CMB estimates of NMHC and the emission inventory showed a good agreement for vehicles, handling and distribution of LP gas, and painting operations; nevertheless, emissions from diesel exhaust and asphalt operations showed differences, and the results suggest that these emissions could be underestimated.

Basic statistics of PM2.5 and PM10 in the atmosphere of Mexico City

The high levels of fine particulate matter in Mexico City are of concern since they may induce severe public health effects as well as the attenuation of visible light. Sequential filter samplers were used at six different sites from 23 February to 22 March 1997. The sampling campaign was carried out as part of the project 'Investigación sobre Materia Particulada y Deterioro Atmosferico-Aerosol and Visibility Evaluation Research'. This research was a cooperative project sponsored by PEMEX and by the US Department of Energy. Sampling sites represent the different land uses along the city, the northwest station, Tlalnepantla, is located in a mixed medium income residential and industrial area. The northeast station, Xalostoc, is located in a highly industrialized area, Netzahualcoyotl is located in a mixed land use area, mainly commercial and residential. Station La Merced is located in the commercial and administrative district downtown. The southwest station is located in the Pedregal de San Angel, in a high-income neighborhood, and the southeast station located in Cerro de la Estrella is a mixed medium income residential and commercial area. Samples were collected four times a day in Cerro de la Estrella (CES), La Merced (MER) and Xalostoc (XAL) with sampling periods of 6 h. In Pedregal (PED), Tlalnepantla (TLA) and Netzahualcoyot1 (NEZ) sampling periods were every 24 h. In this paper the basic statistics of PM2.5 and PM10 mass concentrations are presented. The average results showed that 49, 61, 46, 57, 51 and 44% of the PM10 consisted of PM2.5 for CES, MER, XAL, PED, TLA and NEZ, respectively. The 24-h average highest concentrations of PM25 and PM10 were registered at NEZ (184 and 267 microg/m3) and the lowest at PED (22 and 39 microg/m3). The highest PM10 correlations were between XAL-CES (0.79), PED-TLA (0.80). In contrast, the highest PM2.5 correlations were between CES-PED (0.74), MER-CES (0.73) and TLA-PED (0.72), showing a lower correlation than the PM10 one. The results of the PM10 from 12.00 to 18.00 h at CES and MER presented the highest variability and also the highest median concentrations, meanwhile XAL showed them from 06.00 to 12.00 h. The highest variability and median concentrations of PM2.5 were from 06.00 to 12.00 h for the three stations.

Taking telehealth to the bush: lessons from north Queensland

Networking North Queensland (NNQ) was a two-year project to improve access to health services in rural and remote communities. The project involved email and Internet access in 61 communities, in a region almost three times the size of the UK. Videoconferencing equipment was also installed at 21 sites and a total of 197 h of videoconferencing was recorded at 10 of the remote sites over 12 months. As a result of the project, health consumers enjoyed improved access to medical, specialist, allied health and primary health services. In addition, health service providers had better access to reliable, up-to-date health-care information via intranet and Internet services. Consideration of local issues--local needs and existing resources--was vital to the achievements of the project. Community involvement and community access were also important factors in its success.

Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae

OBJECTIVE

The study was designed to investigate the effect of epidural administration of glucocorticoid on insulin sensitivity.

METHODS

Ten healthy individuals with sciatica underwent a short insulin tolerance test before and twice following (at 24 h and 1 week) a caudal epidural containing 80 mg triamcinolone. Fasting glucose, insulin and cortisol concentrations were also measured.

RESULTS

The rate of glucose disappearance after insulin administration (k(ITT)) fell from 3.6%/min before the epidural to 1.9%/min 24 h afterwards (P=0.001) and returned to pretreatment values by 1 week. Significantly raised fasting insulin and glucose levels also reflected impaired insulin sensitivity immediately after the epidural. Morning cortisol levels were suppressed after the epidural (49 nmol/l at 24 h and 95 nmol/l at 1 week vs 352 nmol/l at baseline; P<0.01).

CONCLUSIONS

Epidural administration of glucocorticoid results in potent suppression of insulin action and this should be taken into account when patients with diabetes require treatment for sciatica.

Precision measurement of the spin-dependent asymmetry in the threshold region of 3He(e, e')

We present the first precision measurement of the spin-dependent asymmetry in the threshold region of 3He(e,e') at Q2 values of 0.1 and 0.2 (GeV/c)2. The agreement between the data and nonrelativistic Faddeev calculations which include both final-state interactions and meson-exchange current effects is very good at Q2 = 0.1 (GeV/c)2, while a small discrepancy at Q2 = 0.2 (GeV/c)2 is observed.

Posttransplantation growth in pediatric liver recipients

The aim of this retrospective analysis was to evaluate the growth of 96 pediatric liver transplant recipients from February 1988 to June 1999. Inclusion criteria were the following: age younger than 18 years, follow-up longer than 1 year, transplantation for a nontumor indication, and no retransplantation. Linear height and growth velocity SD scores were correlated to age, sex, indication for transplantation, immunosuppression, and graft type. Transplant recipients of all ages and indications and both sexes were growth retarded at transplantation. Recipients aged younger than 24 months showed growth within the first year to achieve a height distribution equal to that of an age-matched population. Posttransplantation growth inversely correlated with height standard score at transplantation. Children older than 2 years at transplantation established new growth curves, but remained growth retarded. As children approached the prepubertal growth acceleration, growth deficits frequently were erased. Transplant recipients with biliary atresia and alpha(1)-antitrypsin deficiency showed increased growth performance compared with those who underwent transplantation for chronic hepatitis or fulminant hepatic failure. Boys were less growth retarded at transplantation and showed improved posttransplantation growth performance versus girls. No correlation to immunosuppression or graft type was identified. We conclude that early transplantation of children who show growth retardation is optimal for restoration of growth potential, whereas delaying transplantation in older children impedes potential growth.

SB-236057-A: a selective 5-HT1B receptor inverse agonist

5-HT1B autoreceptors are involved in the control of extracellular 5-HT levels from both the terminal and cell body regions of serotonergic neurons. In this manuscript we review the pharmacological and pharmacokinetic data available for the selective and potent 5-HT1B receptor inverse agonist, SB-236057-A (1'-ethyl-5-(2'-methyl-4'-(5-methyl-1,3,4-oxadiazolyl-2-yl)biphenyl-4-carbonyl)-2,3,6,7-tetrahydrospiro (furo[2,3-f]indole-3,4'-piperidine) hydrochloride). SB 236057-A has been shown to have high affinity for human 5-HT1B receptors (pK(i) = 8.2) and displays 80 or more fold selectivity for the human 5-HT1B receptor over other 5-HT receptors and a range of additional receptors, ion channels and enzymes. In functional studies at human 5-HT1B receptors SB-236057-A displayed inverse agonism (pA(2) = 8.9) using [(35)S]GTPgammaS binding, and silent antagonism (pA(2) = 9.2) using cAMP accumulation. SB-236057-A also acted as an antagonist at the 5-HT terminal autoreceptor as measured by [3H]5-HT release from electrically stimulated guinea pig and human cortical slices. In the guinea pig, pharmacokinetic analysis demonstrated that SB-236057-A was bioavailable and according to in vivo pharmacodynamic assays it enters brain and has a long duration of action. Importantly no side effect liability was evident at relevant doses from anxiogenic, cardiovascular, sedative or migraine viewpoints. In vivo microdialysis studies demonstrated that SB-236057-A is an antagonist in the guinea pig cortex but has no effect on extracellular 5-HT levels per se. In contrast, SB-236057-A increased extracellular 5-HT levels in the guinea pig dentate gyrus. This increase in 5-HT release was comparable to that observed after 14 days of paroxetine administration. SB-236057-A has been a useful tool in confirming that, in either guinea pigs or humans, the terminal 5-HT autoreceptor is of the 5-HT1B subtype. It appears that acute 5-HT1B receptor blockade, by virtue of increased 5-HT release in the dentate gyrus, may provide a rapidly acting antidepressant.

The impact of worldwide drug resistance on the United Kingdom

The incidence of tuberculosis in the United Kingdom, which declined beginning in the middle of the 19th century, began to increase in the late 1980s. The distribution of tuberculosis by geographic area, age, and ethnic group is discussed. Drug resistance is high among U.K. residents born abroad, but the proportion of drug-resistant cases is remaining stable.

An exception to the rule: ectopic ACTH production from functional neuroendocrine tissue in an ovarian dermoid cyst

Ectopic ACTH production accounts for 15% of Cushing's syndrome presentations and is characterized by the presence of an excess of ACTH precursors. However in the case presented here ectopic ACTH production was from functional pituitary tissue within an ovarian dermoid cyst. Endocrine investigations showed that the problem behaved more like pituitary-dependent Cushing's disease and this is discussed. Furthermore, this case is one of familial dermoid cysts, another unusual phenomenon.

The use of low-power laser irradiation for faster vascularization of tissue transplants

We studied the effect of low-power laser irradiation on vascularization and take of transplanted rabbit renal and pancreatic tissue in athymic nude mice. The mean size of the transplant and the number of blood vessels in it were higher in irradiated mice compared to nonirradiated controls. Moreover, the organ-specific structure of the transplants was preserved in irradiated mice, but not in the control group. These findings suggest that low-power laser irradiation can be used for promotion of vascularization and take of tissue transplants.

Stimulation of the growth of human tumor by low-power laser irradiation

We studied the effect of low-power laser on the growth of human gastric adenocarcinoma transplanted to athymic mice. Irradiation shortened the latency of tumor growth in recipients from 4-6 months to 21-24 days. After 17 serial passages on athymic mice, the size of tumor node in irradiated recipients on day 33 after transplantation was 161.1 mm(3) (vs. 10.2 mm(3) in nonirradiated mice). These findings suggest that low-power laser irradiation can stimulate the growth of metastases in patients with a history of malignancy.

On nursing theories and evidence

PURPOSE

To expand the understanding of what constitutes evidence for theory-guided, evidence-based nursing practice from a narrow focus on empirics to a more comprehensive focus on diverse patterns of knowing.

ORGANIZING CONSTRUCT

Carper's four fundamental patterns of knowing in nursing--empirical, ethical, personal, and aesthetic--are required for nursing practice. A different mode of inquiry is required to develop knowledge about and evidence for each pattern.

CONCLUSIONS

Theory, inquiry, and evidence are inextricably linked. Each pattern of knowing can be considered a type of theory, and the modes of inquiry appropriate to the generation and testing of each type of theory provide diverse sources of data for evidence-based nursing practice. Different kinds of nursing theories provide different lenses for critiquing and interpreting the different kinds of evidence essential for theory-guided, evidence-based holistic nursing practice.

SB-272183, a selective 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptor antagonist in native tissue

A novel compound, SB-272183 (5-Chloro-2, 3-dihydro-6-[4-methylpiperazin-1-yl]-1[4-pyridin-4-yl]napth-1-ylaminocarbonyl]-1H-indole), has been shown to have high affinity for human 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptors with pK(i) values of 8.0, 8.1 and 8.7 respectively and is at least 30 fold selective over a range of other receptors. [(35)S]-GTPgammaS binding studies showed that SB-272183 acts as a partial agonist at human recombinant 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptors with intrinsic activities of 0.4, 0.4 and 0.8 respectively, compared to 5-HT. SB-272183 inhibited 5-HT-induced stimulation of [(35)S]-GTPgammaS binding at human 5-HT(1A) and 5-HT(1B) receptors to give pA(2) values of 8.2 and 8.5 respectively. However, from [(35)S]-GTPgammaS autoradiographic studies in rat and human dorsal raphe nucleus, SB-272183 did not display intrinsic activity up to 10 microM but did block 5-HT-induced stimulation of [(35)S]-GTPgammaS binding. From electrophysiological studies in rat raphe slices in vitro, SB-272183 did not effect cell firing rate up to 1 microM but was able to attenuate (+)8-OH-DPAT-induced inhibition of cell firing to give an apparent pK(b) of 7.1. SB-272183 potentiated electrically-stimulated [(3)H]-5-HT release from rat and guinea-pig cortical slices at 100 and 1000 nM, similar to results previously obtained with the 5-HT(1B) and 5-HT(1D) receptor antagonist, GR127935. Fast cyclic voltammetry studies in rat dorsal raphe nucleus showed that SB-272183 could block sumatriptan-induced inhibition of 5-HT efflux, with an apparent pK(b) of 7.2, but did not effect basal efflux up to 1 microM. These studies show that, in vitro, SB-272183 acts as an antagonist at native tissue 5-HT(1A), 5-HT(1B) and 5-HT(1D) receptors.

Meta-analysis of theory-of-mind development: the truth about false belief

Research on theory of mind increasingly encompasses apparently contradictory findings. In particular, in initial studies, older preschoolers consistently passed false-belief tasks-a so-called "definitive" test of mental-state understanding-whereas younger children systematically erred. More recent studies, however, have found evidence of false-belief understanding in 3-year-olds or have demonstrated conditions that improve children's performance. A meta-analysis was conducted (N = 178 separate studies) to address the empirical inconsistencies and theoretical controversies. When organized into a systematic set of factors that vary across studies, false-belief results cluster systematically with the exception of only a few outliers. A combined model that included age, country of origin, and four task factors (e.g., whether the task objects were transformed in order to deceive the protagonist or not) yielded a multiple R of .74 and an R2 of .55; thus, the model accounts for 55% of the variance in false-belief performance. Moreover, false-belief performance showed a consistent developmental pattern, even across various countries and various task manipulations: preschoolers went from below-chance performance to above-chance performance. The findings are inconsistent with early competence proposals that claim that developmental changes are due to tasks artifacts, and thus disappear in simpler, revised false-belief tasks; and are, instead, consistent with theoretical accounts that propose that understanding of belief, and, relatedly, understanding of mind, exhibit genuine conceptual change in the preschool years.

Incipient erosion of biostabilized sediments examined using particle-field optical holography

Laser holography allows images of three-dimensional space at ultra-high resolution to be recorded onto photographic plates. Recorded scenes can be "replayed" with a second laser beam into free space and optically "interrogated" using either a microscope or a camera by sequentially focusing on increasing distances from the hologram in the field of view (optical sectioning). From these sections, information on the relative locations and orientation in space of suspended particles as well as the morphology of particles can be obtained. This paper examines the utility of "in-line" laser holography to discriminate the size and the morphology of sand particles eroded under turbulent shear flow during benthic sediment transport. The influence of a commercially available adhesive polymer (xanthan gum, derived from the bacterium Xanthomonas campestris) on sediment stability and resuspended particle morphology is described. The major implications for carbon and sediment cycling within estuaries are highlighted.

Diabetic foot care: developing culturally appropriate educational tools for Aboriginal and Torres Strait Islander peoples in the Northern Territory, Australia

Evidence shows that Aboriginal and Torres Strait Islander people have the highest national percentage of morbidity in relation to diabetes. Aboriginal and Torres Strait Islander people also suffer the greatest risk of amputation as a complication of diabetes. This participatory action research project sought to discover the opinions of a range of people, including registered nurses, general practitioners, Aboriginal health workers, cross-cultural liaison officers and Aboriginal and Torres Strait Islander people with diabetes. Focus groups provided valuable information regarding relevant issues of foot care education in the Northern Territory. The emergent themes included communication issues, educational resources, changing behaviour and other practical resources required for health education. The themes provided evidence of the inherent issues of foot care for Aboriginal and Torres Strait Islander people and guidance for the development of a visual educational tool. The results have lead to the development of a foot care educational tool that will be used by health-care professionals and clients in urban, community, rural and remote areas. The use of a participant action research process will ensure that the educational tool will be owned by Aboriginal and Torres Strait Islander People and health-care professionals.

Influence of hypoglycaemia, with or without caffeine ingestion, on visual sensation and performance

Full-field visual evoked potentials and visual information processing were measured in 16 normal, healthy subjects during a hyperinsulinaemic clamp. A randomized cross-over design was used across three conditions: hypoglycaemia and caffeine; hypoglycaemia and placebo; and euglycaemia and caffeine. The latency of the P100 component of the pattern-reversal visual evoked potential increased significantly from rest to hypoglycaemia, but no effect of caffeine was found. Subjects were subsequently divided into two median groups based on the increase in P100 latency in the placebo condition (Group 1, +0.5 ms; Group 2, +5.6 ms). In the absence of caffeine, an inverse correlation between the increase in P100 latency from rest and a deterioration in visual movement detection was found for Group 2, but not for Group 1. Caffeine ingestion resulted in a further increase in P100 latency, from rest to hypoglycaemia, for subjects in Group 2. Hypoglycaemia in the absence of caffeine produces changes in visual sensation from rest to hypoglycaemia. In those subjects most sensitive to the effects of hypoglycaemia (Group 2), the increase in P100 latency was associated with poorer performance in tests of visual information processing. Caffeine ingestion produced further increases in P100 latency in these subjects.

Donor WBCs can persist and transiently mediate immunologic function in a murine transfusion model: effects of irradiation, storage, and histocompatibility

BACKGROUND

Donor WBCs are responsible for numerous transfusion complications, but little is known concerning the natural history of their clearance following transfusion or of their function in the recipient's circulation. A murine transfusion model was developed to investigate the effects of blood component characteristics and histocompatibility on donor WBC survival kinetics and function.

STUDY DESIGN AND METHODS

To investigate the effects of storage and irradiation, fresh whole blood and blood stored for 1, 2, and 6 weeks at 4 degrees C, all from male C57b (H2K(b)) mice, was transfused to female Balb/c (H2K(d)) mice. To study the effect of histocompatibility, blood was also transfused from C57b mice to Balb/c, FVB, C3H, and SW (outbred) mice. To investigate the xenogeneic setting, blood from humans, rats, and rabbits was transfused to Balb/c mice. Samples were collected weekly after transfusion, and the donor WBCs were analyzed, targeting the Y-chromosome with quantitative PCR. To investigate donor WBC function, dinitrochlorobenzene (DNCB) sensitivity was induced in donor and recipient mice, and the transfusion recipients were observed for hypersensitivity to DNCB.

RESULTS

Donor WBCs had reduced in vivo survival equivalent to their period of storage ex vivo at 4 degrees C. Irradiation of donor blood produced no observable difference in donor WBC survival. Allogeneic male donor WBCs persisted (100-<1 cell/microL) in female Balb/c recipient mice blood over 6 weeks. Donor WBC survival kinetics displayed an early MHC-dependent phase, which was followed by a more rapid phase that was not influenced by donor-recipient MHC differences. All donor WBCs were cleared within 24 to 48 hours. DNCB sensitivity was passed through transfusion, where it was transiently expressed in naive recipients.

CONCLUSION

The clearance of donor WBCs in the murine transfusion model is much slower than that in humans. Allogeneic donor WBC clearance may be biphasic, involving MHC-dependent as well as MHC-independent mechanisms. DNCB sensitivity can be transferred transiently to a naive recipient.

Meta-analysis of theory-of-mind development: the truth about false belief

Research on theory of mind increasingly encompasses apparently contradictory findings. In particular, in initial studies, older preschoolers consistently passed false-belief tasks-a so-called "definitive" test of mental-state understanding-whereas younger children systematically erred. More recent studies, however, have found evidence of false-belief understanding in 3-year-olds or have demonstrated conditions that improve children's performance. A meta-analysis was conducted (N = 178 separate studies) to address the empirical inconsistencies and theoretical controversies. When organized into a systematic set of factors that vary across studies, false-belief results cluster systematically with the exception of only a few outliers. A combined model that included age, country of origin, and four task factors (e.g., whether the task objects were transformed in order to deceive the protagonist or not) yielded a multiple R of .74 and an R2 of .55; thus, the model accounts for 55% of the variance in false-belief performance. Moreover, false-belief performance showed a consistent developmental pattern, even across various countries and various task manipulations: preschoolers went from below-chance performance to above-chance performance. The findings are inconsistent with early competence proposals that claim that developmental changes are due to tasks artifacts, and thus disappear in simpler, revised false-belief tasks; and are, instead, consistent with theoretical accounts that propose that understanding of belief, and, relatedly, understanding of mind, exhibit genuine conceptual change in the preschool years.

Signalling pathways regulating the dephosphorylation of Ser729 in the hydrophobic domain of protein kinase Cepsilon upon cell passage

We have recently demonstrated that in quiescent fibroblasts protein kinase C (PKC) epsilon(95) is phosphorylated at Ser(729), Ser(703), and Thr(566) and that upon passage of quiescent cells phosphorylation at Ser(729) is lost, giving rise to PKCepsilon(87). Ser(729) may be rephosphorylated later, suggesting cycling between PKCepsilon(87) and PKCepsilon(95). Here we show that the dephosphorylation at Ser(729) is insensitive to okadaic acid, calyculin, ascomycin C, and cyclosporin A, suggesting that dephosphorylation at this site is not mediated through protein phosphatases 1, 2A or 2B. We demonstrate that this dephosphorylation at Ser(729) requires serum and cell readhesion and is sensitive to rapamycin, PD98059, chelerythrine, and Ro-31-8220. These results suggest that the phosphorylation status of Ser(729) in the hydrophobic domain at Ser(729) is regulated independently of the phosphorylation status of other sites in PKCepsilon, by a mTOR-sensitive phosphatase. The mitogen-activated protein kinase pathway and PKC are also implicated in regulating the dephosphorylation at Ser(729).

Communication of the three Rs within establishments: some problems and solutions. Report of a LASA Alternatives Section meeting. Laboratory Animal Science Association

A meeting was organised by the Laboratory Animal Science Association (LASA) Alternatives Section to provide a forum in which ideas for strategies to raise awareness of the Three Rs could be discussed. One of the main objectives of the meeting was to identify effective strategies which could feasibly be implemented at establishments. In general, there are two main ways in which Three Rs information can be obtained and communicated. Individuals can be assigned to a role with specific responsibilities (for example, a named alternatives expert), or committees can be established, with a remit to find ways to reduce, refine and/or replace animal use (for example, an alternatives committee). The meeting involved invited speakers who are engaged in obtaining and communicating Three Rs information, and this report presents a summary of the advantages and limitations of various approaches that are being undertaken.

Post-hospital nursing: shortage, shifts, and scripts

This article offers a critique of nursing's focus during this critical turn in post-hospital nursing with evolving, nonmedical, nonclinical notions of human health. It raises some seminal questions about nursing's ground-of-being in relation to its survival for a new and different human health script. The call is not for more--old script nursing and nurses, but less and different--transformed nursing and nurses, grounded in mature disciplinary, philosophical values, knowledge, and skills that converge with evolving public and system realities: real, surreal, virtual, and timeless. The fewer, different, transformed nurses will need to be grounded in nursing, while simultaneously transdisciplinary and, paradoxically, beyond nursing.

A national confidential enquiry into community acquired pneumonia deaths in young adults in England and Wales. British Thoracic Society Research Committee and Public Health Laboratory Service

BACKGROUND

The aim of this study was to describe the frequency, causal pathogens, management, and outcome of a population of young adults who died from community acquired pneumonia (CAP).

METHODS

Pneumonia deaths in England and Wales in adults aged 15-44 were identified between September 1995 and August 1996. Patients with underlying chronic illness including HIV infection were excluded. Clinical details for each case were collected from the hospital and general practitioner records.

RESULTS

Death from CAP was identified in 27 previously well young adults (1.2 per million population per year). Twenty were known to have consulted a GP for this illness. Nine received antibiotics before hospital admission. A causative pathogen was identified in 17 cases (Streptococcus pneumoniae in eight). Bacteraemia was present in seven. All patients who reached a hospital ward received antibiotics (69% within two hours of admission). The British Thoracic Society antibiotic guidelines for severe CAP were followed in only 10 cases. Cardiac arrest at home or on arrival at hospital occurred in six cases, one of whom was successfully resuscitated. Of the remaining 21 patients, 71% had two or more markers of severe CAP. All 22 who were admitted reached an intensive care unit, but 11 of these required transfer to another hospital for some aspect of intensive care. One third of patients died within 24 hours of presenting to the hospital.

CONCLUSIONS

Death from CAP in previously fit young adults still occurs. While some deaths might be preventable by better patient management, most are unlikely to be preventable by current management practices.

Transverse asymmetry AT' from the quasielastic 3He(e,e') process and the neutron magnetic form factor

We have measured the transverse asymmetry A(T') in 3He(e,e(')) quasielastic scattering in Hall A at Jefferson Laboratory with high precision for Q2 values from 0.1 to 0.6 (GeV/c)(2). The neutron magnetic form factor G(n)(M) was extracted based on Faddeev calculations for Q2 = 0.1 and 0.2 (GeV/c)(2) with an experimental uncertainty of less than 2%.

Phase 1 trial of a single dose of recombinant human interleukin-12 in human immunodeficiency virus-infected patients with 100-500 CD4 cells/microL

A phase 1 dose-escalation trial of a single subcutaneous dose of recombinant human (rh) interleukin (IL)-12 was conducted in medically stable human immunodeficiency virus (HIV)-infected patients with 100-500/microL absolute CD4(+) T lymphocytes. Subjects at each dose level were randomly assigned (3:1) to receive rhIL-12 or placebo. Among the 47 subjects enrolled, rhIL-12 was well tolerated at doses of 3-300 ng/kg, but 4 of 5 subjects who received rhIL-12 at 1000 ng/kg had severe adverse events. Dose-related increases in serum interferon-gamma occurred after rhIL-12 administration at doses > or =30 ng/kg. There was no effect of rhIL-12 on plasma HIV RNA or absolute CD4(+) T cell counts. However, dose-related increases in absolute CD8(+) T and NK cells were observed in subjects assigned to rhIL-12 doses of 30-300 ng/kg. Single rhIL-12 doses of 30-300 ng/kg were well tolerated and had biologic activity that could potentially be of benefit in the treatment of HIV disease or its complications.

Electrocardiographic ST-segment changes during acute, severe isovolemic hemodilution in humans

BACKGROUND

Controversy exists regarding the lowest blood hemoglobin concentration that can be safely tolerated. The authors studied healthy resting humans to test the hypothesis that acute isovolemic reduction of blood hemoglobin concentration to 5 g/dl would produce an imbalance in myocardial oxygen supply and demand, resulting in myocardial ischemia.

METHODS

Fifty-five conscious healthy human volunteers were studied. Isovolemic removal of aliquots of blood reduced blood hemoglobin concentration from 12.8 +/- 1.2 to 5.2 +/- 0.5 g/dl (mean +/- SD). Removed blood was replaced simultaneously with intravenous fluids to maintain constant isovolemia. Hemodynamics and arterial oxygen content (Cao2) were measured before and after removal of each aliquot of blood. Electrocardiographic (ECG) changes were monitored continuously using a Holter ECG recorder for detection of myocardial ischemia.

RESULTS

During hemodilution, transient, reversible ST-segment depression developed in three subjects as seen on the electrocardiogram during hemodilution. These changes occurred at hemoglobin concentrations of 5-7 g/dl while the subjects were asymptomatic. Two of three subjects with ECG changes had significantly higher heart rates than those without ECG changes at the same hemoglobin concentrations. When evaluating the entire study period, the subjects who had ECG ST-segment changes had significantly higher maximum heart rates than those without ECG changes, despite having similar baseline values.

CONCLUSION

With acute reduction of hemoglobin concentration to 5 g/dl, ECG ST-segment changes developed in 3 of 55 healthy conscious adults and were suggestive of, but not conclusive for, myocardial ischemia. The higher heart rates that developed during hemodilution may have contributed to the development of an imbalance between myocardial supply and demand resulting in ECG evidence of myocardial ischemia. However, these ECG changes appear to be benign because they were reversible and not accompanied by symptoms.

Cumulation characteristics of cisatracurium and rocuronium during continuous infusion

PURPOSE

The dissimilar pharmacokinetic properties of cisatracurium (CIS) and rocuronium (ROC) predict different potential for drug cumulation when these drugs are administered by continuous infusion. A study was therefore undertaken to compare cumulation potential of CIS and ROC during surgical procedures of relatively long duration (2-4 hr).

METHODS

Sufentanil/propofol-N2O anesthesia was administered to 40 ASA I and II adults. In a double-blind protocol, patients were randomly allocated to receive a continuous i.v. infusion of either CIS or ROC, titrated in progressive increments or decrements as required to achieve and maintain 95 +/- 5% depression of the T1 response of the adductor pollicis muscle, using a Datex NMT-100 Relaxograph EMG monitor applied at the wrist. At the end of surgery, 60 microg x kg(-1) neostigmine plus 15 microg x kg(-1) atropine were administered for reversal.

RESULTS

The duration of infusion was 104 +/- 33 min in group CIS and 110 +/- 23 min in group ROC (P=NS). In both groups, a progressive decrease in potency-adjusted infusion rates was observed after 30 min, then stabilized beyond 60 min. When allowing for an initial period of stabilization, mean potency-adjusted infusion requirements were: CIS 0.81 +/- 0.02 microg x kg(-1) x min(-1) and ROC 5.58 +/- 1.94 microg x kg(-1) x min(-1). There were no differences between groups at any time with regard to potency-adjusted infusion requirements necessary to maintain 90-99% block (P=NS). However, drug costs/hr for maintenance of neuromuscular block were less with CIS ($3.57 +/- 0.09) than with ROC ($6.03 +/- 0.27), P < 0.001.

CONCLUSION

When adjusted to equipotency, infusion requirements of CIS and ROC vary at similar rates during general anesthesia. Despite pharmacokinetic differences, neither drug demonstrates cumulation for infusion lasting up to 3.5 hr.